Skip to main content Skip to site navigation

Improving Health in East Palo Alto
Incorporating a Health Element into a city's planning process


East Palo Alto (EPA) is the most racially and economically diverse city in San Mateo County.  It contains some of the largest pockets of affordable housing on the peninsula and has great potential to support health, yet has some of the most dire health disparities.

East Palo Alto residents have higher rates of asthma and diabetes than County residents overall. A quarter of EPA residents report they have fair or poor health compared to 16% of County residents who report the same. EPA residents also report getting less physical activity than County residents and have 32% of residents who experience obesity compared with 19% of County residents.[1]

Read the full case study here.

The Solution: Planning for Health

A General Plan is often considered the ‘constitution’ of a city. It guides long-term development through seven required elements or chapters. Each element creates a vision and plan for a specific aspect of daily life, for example housing, transportation, safety and open space. In a move showing deep commitment to the well-being of its citizens, East Palo Alto took the opportunity to link health improvements to the City’s long range planning process during the update of its General Plan. To do this, East Palo Alto included a Health Element in the process of updating their General Plan. While a Health Element is not one of the required components of a General Plan update, the City showed visionary leadership in taking it on.

East Palo Alto applied for and received a $1 million Sustainable Communities Planning Grant from The California Strategic Growth Council (SGC) to update their plan with a Health Element, and in March 2013, the City Manager signed contracts with the consulting firm Raimi + Associates and the SGC. Raimi + Associates managed the process, conducting outreach, doing research, writing the new plan, and creating zoning to enable the plan to come to life. Get Healthy San Mateo County (GHSMC) staff served in an advisory capacity by providing data, sharing best practices, co-facilitating meetings, and reviewing draft documents to help build a plan that will improve wellness by building healthy, equitable communities.

The process involved community members through extensive engagement efforts and the final Health Element reflects a deep level of community expertise that could only be shared by people truly in tune with EPA. The final EPA Health Element contains innovative solutions to address local health inequities by:

  • Creating parks and open space to create safe and attractive places for recreation and exercise
  • Pursuing additional affordable housing and support policies that discourage displacement of existing residents
  • Prioritizing active transportation systems such as walking, biking, and transit use
  • Working towards “Vision Zero”—a roadway system with no pedestrian or bicycle fatalities or serious injuries
  • Promoting access to fresh foods through promoting healthy corner stores and community gardens and restricting liquor stores and fast food
  • Ensuring housing is healthy and safe through healthy design guidelines and code enforcement
  • Measuring progress through continually tracking the health status of residents over time

You can read East Palo Alto’s draft General Plan here.

Ingredients for Success: Deep community engagement

Over the course of two and a half years, the City and the consulting team conducted thorough multi-lingual outreach to engage residents in creating a Health Element through workshops, interviews, focus groups, town hall meetings, a robust website, and advisory committee meetings. The outreach team established two advisory committees, one for the overall General Plan update and one for the Westside area, which due to high housing pressures became a specific planning focus throughout the process.

All together, the city held approximately 33 community outreach events attended by about 400 people. These efforts led to deep insights into the factors that affect residents’ health that aren’t always immediately thought of in relation to health. For example, residents identified displacement and gentrification as issues with serious consequences for their health. Because of this organic input and the research linking healthy housing to improved health outcomes, EPA identified preventing displacement as a health priority in the Health Element. Residents also identified overcrowding, the lack of middle income jobs, and inadequate transportation as potential health issues, all of which are acknowledged by the Health Element.


The General Plan update and Health Element were initiated by former Planning Manager Brent Butler who was committed to health. Despite staff changes, current staff and City leadership remains committed to building health and equity in EPA – and so the vision for a healthy East Palo Alto lives on.


The final plan was approved by the EPA City Council on October 4, 2016. City staff plans to begin implementation with parks and open space planning and zoning updates. Get Healthy SMC staff will continue to work with the city to monitor progress in improving health outcomes as the plan rolls out in the coming years.

For cities on the fence about including a Health Element in their planning process, Planning Manager Guido F. Persicone says, “My advice to cities is definitely do it. [A Health Element] is not required by law but at the end of the day our job is to focus on the long term growth and resources of the city and our greatest resource is the people who live here.”

For more information on how to incorporate a Health Element into your planning process, check out ChangeLab Solutions’ and Raimi and Associates’ resource How to Create and Implement Healthy General Plans. Contact Maeve Johnston at to learn how Get Healthy San Mateo County can help your city incorporate health in your planning process.

[1] 2004 Ask CHIS Neighborhood Edition.